446 ON A CASE OF EXCISION OF THE KNEE-JOINT 



selves witnessed — viz. that of transverse fracture of the patella, treated by 

 laying open the joint, drilling the fragments obliquely, and tying them together 

 by means of strong silver wire. Being apprehensive that blood and serum 

 might be effused into the joint to such a degree as to produce inconvenient 

 tension unless a free exit was provided, I resolved to introduce a drain at a 

 dependent part of the articular cavity ; but I feared that, if a caoutchouc tube 

 was used, it might be rendered inefficient b}^ being compressed between the 

 condyle of the femur and the neighbouring tissues. I therefore had recourse 

 to the horsehair, introducing into the posterior and outer part of the joint a 

 drain, about a quarter of an inch in thickness, by means of the dressing-forceps 

 employed as before described. It worke^ to admiration ; for though there 

 w^as, indeed, in the first twenty-four hours, a very copious sanguineo-serous 

 effusion, as shown by the soaking of the antiseptic gauze, yet not the slightest 

 swelling of the joint occurred, and, after nine days, the small remains of the 

 drain, which had been previously reduced at successive periods, were withdrawn, 

 to allow the puncture to close. The drain of horsehair w^as as pure and white ^ 

 as if it had been merely dipped in water ; having been washed quite clean of 

 the blood which first occupied its interstices by the colourless serum which, 

 after the cessation of the original sanguineous effusion, had been the only dis- 

 charge. I was so much impressed with the satisfactory working of the horsehair 

 drain in that case that we have since employed it in preference to the caout- 

 chouc tube in all our wounds, and have had good reason to be pleased with the 

 change. (If it be necessary to reintroduce a horsehair drain, it is readity done 

 by taking a wisp of hair of half the thickness required, bending it in the middle 

 at a sharp angle over a probe, and tying a piece of carbolized silk round it close 

 to the probe, on withdrawal of which the drain is left with a rounded end 

 which passes readily into the interior of the wound.) 



In the case of this little girl the horsehair drain has worked perfectly well 

 in spite of the pressure to which it was subjected. The flow of blood and serum 

 was, in the first twenty-four hours, extremely free, but there was no appearance 

 of the retention of any of it within the wound. On the occasion of the last 

 dressing, two days ago, more than half of the drain was removed. That dressing 

 took place after an interval of three days, and it would be superfluous to change 

 the dressing to-day, were it not that we may, perhaps, be justified, by the further 

 diminution of the discharge, in withdrawing the remainder of the drain entirely 

 so as to permit its track to close. 



^ I used white horsehair in this case simply because I did not happen to have at hand any of the 

 black, which is generally preferable, because the individual hairs are thicker, while the dark colour has 

 the advantage of making them more conspicuous, especially when they are used for sutures. 



